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Supportive Care in Cancer

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01-01-2016 | Original Article

Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process

Authors: Joanne M Shaw, Melanie A Price, Josephine M Clayton, Peter Grimison, Tim Shaw, Nicole Rankin, Phyllis N Butow

Published in: Supportive Care in Cancer | Issue 1/2016

Abstract

Purpose

People with cancer and their families experience high levels of psychological morbidity. However, many cancer services do not routinely screen patients for anxiety and depression, and there are no standardized clinical referral pathways. This study aimed to establish consensus on elements of a draft clinical pathway tailored to the Australian context.

Methods

A two-round Delphi study was conducted to gain consensus among Australian oncology and psycho-oncology clinicians about the validity of 39 items that form the basis of a clinical pathway that includes screening, assessment, referral and stepped care management of anxiety and depression in the context of cancer. The expert panel comprised 87 multidisciplinary clinician members of the Australian Psycho-oncology Co-operative Research Group (PoCoG). Respondents rated their level of agreement with each statement on a 5-point Likert scale. Consensus was defined as >80 % of respondents scoring within 2 points on the Likert scale.

Results

Consensus was reached for 21 of 39 items, and a further 15 items approached consensus except for specific contextual factors, after two Delphi rounds. Formal screening for anxiety and depression, a stepped care model of management and recommendations for inclusion of length of treatment and time to review were endorsed. Consensus was not reached on items related to roles and responsibilities, particularly those not applicable across cancer settings.

Conclusions

This study identified a core set of evidence- and consensus-based principles considered essential to a stepped care model of care incorporating identification, referral and management of anxiety and depression in adult cancer patients.

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Title: Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process
Authors: Joanne M Shaw
Melanie A Price
Josephine M Clayton
Peter Grimison
Tim Shaw
Nicole Rankin
Phyllis N Butow
Publication date: 01-01-2016
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 1/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-015-2742-5

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